Cardiomegaly: Heart Chamber Enlargement

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Questions and Answers

What is a key indicator of left atrial enlargement on a plain radiograph?

  • Oblique measurement greater than 7 cm from the midpoint of left main bronchus (correct)
  • Right atrial convexity exceeding 50% of cardiovascular height
  • Rounded left heart border with uplifted cardiac apex
  • Splain of the carina with acute tracheal bifurcation angle

Which sign indicates posterior displacement of the left mainstem bronchus in left atrial enlargement?

  • Double density sign
  • Increased tracheal bifurcation angle
  • Elevated left upper lobe bronchus
  • Walking man sign (correct)

In the context of left atrial enlargement, what does the term 'splaying of the carina' refer to?

  • Flattening of the left heart border near the pulmonary outflow track
  • Markedly enlarged left atrium extending beyond the right atrial margin
  • Increased angulation of the tracheal bifurcation (correct)
  • Elevation of the left upper lobe bronchus

What characteristic is associated with right atrial enlargement on a plain radiograph?

<p>Gross enlargement of the right atrial shadow with increased convexity (A)</p> Signup and view all the answers

Which radiographic sign is NOT typically associated with left atrial enlargement?

<p>Rounded cardiac apex from left ventricular hypertrophy (D)</p> Signup and view all the answers

What is the effect of right ventricular enlargement on the cardiac apex?

<p>Displacement in a leftward direction (B)</p> Signup and view all the answers

How is right atrial enlargement typically identified on a radiographic image?

<p>By bulging or elongation of the right heart border (D)</p> Signup and view all the answers

What characteristic change occurs to the cardiac apex with left ventricular enlargement?

<p>Left-inferior displacement (B)</p> Signup and view all the answers

What is the maximum permissible distance of the right atrial shadow from the midline in the case of enlargement?

<p>5.5 cm (A)</p> Signup and view all the answers

Which condition can lead to an enlarged left atrium with a normal cardiac silhouette?

<p>Mitral stenosis (B)</p> Signup and view all the answers

Flashcards

Right Ventricular Enlargement - Apex Shift

Right ventricular enlargement causes the cardiac apex to shift leftward.

Right Ventricular Enlargement - Lateral View

An enlarged right ventricle can cause retrosternal fullness and the anterior cardiac border to touch more than the lower third of the sternum.

What does Right Atrial Enlargement affect?

The right atrium forms the right heart border, and enlargement causes lateral bulging or elongation of this border.

Left Ventricular Enlargement - Apex Shift

Left ventricular enlargement usually causes the cardiac apex to shift in a left-inferior direction.

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Left Ventricular Enlargement - Lateral View

On a lateral view, an enlarged left ventricle manifests as posterior displacement of the left ventricular margin.

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Left Atrial Enlargement on Chest X-ray

The distance between the midpoint of the left main bronchus and the right edge of the left atrium is greater than 7 cm. This indicates an enlarged left atrium.

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Left Atrial Enlargement

The left atrium is enlarged beyond its normal size. This can be observed on a chest X-ray by looking at the right border of the left atrium.

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Splaying of the Carina - Left Atrial Enlargement

An enlarged left atrium can cause the carina (the point where the trachea splits into two bronchi) to splay out, seen on a frontal chest x-ray. This is due to the increased pressure from the enlarged left atrium.

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Elevating Left Upper Lobe Bronchus - Left Atrial Enlargement

An enlarged left atrium can elevate the left upper lobe bronchus, visible on a lateral chest X-ray. The enlarged atrium presses upwards on the bronchus.

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Walking Man Sign - Left Atrial Enlargement

On a lateral chest X-ray, an enlarged left atrium pushes the left main bronchus backward, creating a distinctive 'walking man' sign.

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Study Notes

Cardiomegaly: Right Ventricular Enlargement

  • The right ventricle is the most anterior heart chamber.
  • Right ventricular enlargement displaces the cardiac apex leftward.
  • Left ventricular enlargement displaces the apex in a left-inferior direction.
  • Radiographic features: retrosternal fullness, anterior cardiac border extends more than lower 1/3 of the sternal length.

Cardiomegaly: Right Atrial Enlargement

  • The right atrium forms the right heart border.
  • Right atrial enlargement causes lateral bulging or elongation of the right heart border.
  • Normal right atrial shadow: no more than 50% of cardiovascular height and no more than 5.5 cm from the midline.

Cardiomegaly: Left Ventricular Enlargement

  • The left ventricle forms the left heart border.
  • Left ventricular enlargement displaces the cardiac apex in a left-inferior direction.
  • Radiographic features: posterior displacement of the left ventricle.

Cardiomegaly: Left Atrial Enlargement

  • The left atrium is the most posterior cardiac chamber.
  • Causes: Mitral regurgitation and Mitral stenosis
  • Radiographic findings: widening of the carina, elevation of the left upper lobe bronchus, increased distance of the right border of the left atrium from the midpoint of the left mainstem bronchus ( > 7 cm), enlarged left atrial appendage (third mogul sign), and a widened carinal angle.
  • Additional findings: atrial escape and prominence of the upper posterior cardiac convexity.
  • Left ventricle dilation causes leftward, inferior, and posterior displacement of the left heart border.
  • Left ventricle hypertrophy may cause rounding of the cardiac apex.

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